Endocrine Abstracts

Objectives: Acromegaly may arise with several clinical presentations and cardiac involvement is the most important factor affecting the course of the disease.

Case: A 32-years old man admitted to hospital complaining with shortness of breath. After initial evaluation he was diagnosed as ‘cardiac failure’. Cardiac evaluation revealed that he had ‘dilated cardiomyopathy’ with ejection fraction (EF) of 20%, global hypokinesia without valvular disease and coronary angiography was detected as normal. After immediate cardiac treatment he was consultated to endocrinology because of hyperglycemia. When the patient evaluated for hyperglycemia, physical examination findings consistant with acromegaly. He was diagnosed as acromegaly with high IGF-1 and GH level and 19 mm macroadenoma in pituitary MRI. Because of heart failure, surgery was delayed and medical therapy was initiated. After 6 months of therapy with high dose somatostatin analogue treatment, his cardiac status did not show any improvement and we decided transnasal transsphenoidal adenomectomy. After surgery he was not in remission and somatostatin analogues were initiated again. At the 6 months of additional therapy, IGF-1 and GH level were not in normal range. We decided to add pegvisomant to therapy. At the 2nd week of combination therapy, he developed severe cardiac failure with EF 10% and therapy was discontinued. After cessation of pegvisomant, his symptoms revealed minimally.

Conclusion: As we know cardiac problems are the first leading cause of death in acromegaly. Cardiac involvement may appear any of the followings; hypertension, valvular heart diseases, arrhythmias, hypertrophic cardiomyopathy and dilated cardiomyopathy. Most of the patients treated with pegvisomant show decreased cardiac muscle mass in hypertrophic cardiomyopathic patients. There is no data about pegvisomant use in acromegalic patients with dilated cardiomyopathy. Should we use it cautially in dilated cardiomyopathic patients?